Impact of Psychosocial Factors on Health Services Utilization and Cost of Care in Blood and Marrow Transplant Patients

Abstract

ObjectiveS: Hematopoietic cell transplant (HCT) for blood and bone marrow disorders is a costly procedure that requires complex treatment regimens. In addition to disease-related factors, comorbidity and psychosocial characteristics can affect transplant outcomes and cost of care. Our objective was to examine the impact of psychosocial factors and variations in health insurance coverage on post-HCT health services utilization. MethOdS: We conducted a retrospective observational cohort study including 96 autologous and 40 allogeneic adult recipients transplanted in 2013-2016 at our medical center. Patient suitability for transplant was scored using an abbreviated 6-item Psychosocial Assessment of Candidates for Transplantation (PACT) scale ranging from 0 (poor) to 4 (excellent). Patients were stratified into two groups: low risk (score 3 and 4) and moderate/high risk (score 1 and 2). We analyzed the association of psychosocial score with the hospital length of stay during the first year after HCT. ReSultS: The most frequent indication for autologous transplant was multiple myeloma (73%), and for allogeneic, acute myeloid leukemia (43%). The disease risk at transplant was high in 22.5% of autologous, and in 15% of allogeneic transplants. The median survival time after transplant was 773 (4-1638) days for autologous and 442 (9-1613) days for allogeneic. The length of stay during subsequent hospitalizations in the first year was 1.8 days (SD= 4.09) for autologous and 19.3 (SD= 28.58) for allogeneic. Factors associated with shorter hospital stay in autologous transplants were higher PACT scores (RR 0.43, 95%CI 0.75-0.09 p= .011), availability of a care partner (RR 0.44 95%CI 0.78-.11 p= .012) and underinsured/Medicaid status (RR 0.81 95%CI 0.01-1.63 p= .05). In the allogeneic group higher PACT scores (RR 0.74 95%CI 0.92-0.56 p< .0001) were associated with shorter hospitalization periods. cOncluSiOnS: Psychosocial factors, availability of a care partner and health insurance can predict post-HCT healthcare cost. A prospective psychosocial evaluation score may have a prognostic significance for transplant outcomes.